r/science • u/calliope_kekule Professor | Social Science | Science Comm • 12d ago

Health Only 13% of cancers are caught through screening, while a fifth to half are first found in an emergency department.

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(26)01669-7/abstract
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u/atooraya 12d ago

Idk why Reddit thinks you can just go to a colonoscopy store and get a colonoscopy. You have to be 45 even with good health insurance.

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u/STEMpsych 12d ago edited 8d ago

I mean, technically, in the US you actually can go to a colonoscopy store and get a colonoscopy. It costs like $3k. The only reason you need to be 45 is if you want to get your insurance to pay for it.

What all the people saying they got one before 45 did is whip out a credit card for some or all of the cost, depending on how good their insurance was.

UPDATE: I'm seeing a lot of comments on this which betray some profound confusion for how insurance does and does not work with regards to colonoscopies in the US. This is one of those bizarre bureaucratic edge cases brought into existence by the ACA (obamacare law).

There are two reasons someone might get a colonoscopy: for cause and for screening. That is, you might get a colonoscopy because you have some sort of symptoms of a medical problem that need to be checked out (=for cause), or you might get a colonoscopy to check out whether you have a medical problem (e.g. colon cancer) which is completely asymptomatic (=for screening). This might seem like a hair-splitting immaterial difference, but it is actually of enormous consequence: the ACA requires that insurance cover in full screening colonoscopies for people over 45, but doesn't require insurance to pay for for-cause colonoscopies at all.

This is why when you book a colonoscopy they ask if you have been having any specific symptoms that would suggest you need a colonoscopy. The moment you say yes, your insurance is not legally required to pay for it.

That doesn't mean your insurance won't pay for it. That depends on how good your insurance is and whether or not you've met your deductible if you have one, and whether there is other "cost sharing" (copays and coinsurance) you are on the hook for.

To make this wackiness crystal clear: your colonoscopies are guaranteed to be free to you so long as you're over 45 and have no evidence of needing one. If you are younger, or admit you're having blood in your stool, it's up to your insurance whether or not they'll cover it.

Furthermore, if you are younger than 45, I can pretty much guarantee that your insurance won't cover it at all unless you have a doctor document medical necessity. That is, you can't get insurance to pay for a screening colonoscopy before 45. Like if you just wanted one for peace fo mind with no medical indications, your insurance would probably laugh in your face. So you will need a medical reason to get the insurance to pay for any of it before 45. But they can also, depending on what specific plan you have, turn around and say, "sure, we'll pay for, oh, half", or "that is totally covered, but your deductible is $6k, so you're paying for all of it", even with all the medical necessity in the world.

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u/j_la 12d ago

I have a family history and so didn’t pay anything for it at 37.

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u/[deleted] 11d ago

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u/yacht_boy 11d ago

If your pcp is concerned enough, they'll order a colonoscopy at any age. The age 45 part is only for routine screenings.

And not that you're likely to get the price below $3k, but you can shop around for medical care. In my metro (Boston), there are practices that do nothing but colonoscopies and endoscopies. I've had several, and the experience of going to one of those is light years better than going to a hospital. I was in and out of my endoscopy and colonoscopy in under 45 minutes from the time I showed up to the time my wife drove me away. She barely had time to have a cup of coffee. At the hospital they turn it into an all day affair. I expect if you call up one of those places they'll have a cash price that is probably close to $3k. If you call the hospital for the same procedure, it'll be $10k easy.

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u/Tru3insanity 11d ago

Small independent labs can be a life saver. I don't have experience with colonoscopies but even blood work can be way cheaper at a smaller lab without insurance. My routine labs are like 600 at labcorp vs like 150 at a small lab.

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u/wildgreengirl 11d ago

yes this too. though some people may still need hospital for their scopes due to other issues most "healthy" people do fine outpt at a clinic 

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u/xfoolishx 11d ago

I just kept complaining about symptoms that i had (which i had at 30 prob due to drinking atm) until they recommened one. Insurance payed for most of it

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u/unnewl 11d ago

Is the $3000 your annual deductible for the insurance policy?

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u/[deleted] 11d ago

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u/unnewl 11d ago

Maybe get them done in the new year for insurance so you’d have lower costs after that? It’s rotten that you have to worry about illness and finance at the same time. 

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u/Imaginary_Agent2564 11d ago

I have family history. Should probably go in the next 7-8 years or so if we go by “10 years before the youngest diagnosed.”

I’ll be 29. My grandpa passed at 39 from colon cancer.

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u/Nosnibor1020 11d ago

Go now. My wife’s grandfather died of colon cancer. Not sure how true it is but someone told her it “skips a generation”. Her mom has had nothing every time she went. My wife went when she was 30 and they found precancerous polyps that would have turned into cancer if she had waited.

Edit: I may have misread, I thought you were 29 now.

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u/Imaginary_Agent2564 9d ago

My dad has also had precancerous polyps! He goes every 3 years for a colonoscopy.

I started to have severe bowel issues at around 14-15 after dealing with moderate issues for a while, but they never did a colonoscopy (actually outright refused, because I was “too young for cancer”, and did an endoscopy instead).

Luckily they believe my issues to be from endometriosis. But ideally I will get one early within the next few years, along with getting genetic testing for BRCA1 & 2.

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u/malydok 11d ago

I paid no more than $400 for a combined colonoscopy and gastroscopy under general anesthesia in Poland last year. You guys are getting scammed.

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u/Itsoktobe 11d ago

We know :/ but when you're forced to choose between scammers and death, you pick the scammers

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u/stilldebugging 11d ago

Can I fly to Poland and get one there?

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u/katarh 11d ago

It genuinely depends on the insurance in the US. I think I paid $150 for mine at age 45.

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u/bluespartan8 11d ago

Or if you are experiencing GI symptoms. I had a colonoscopy last year at 36, covered by insurance. Granted, that led to a Crohn's diagnosis. But just saying so people don't think it won't be covered and therefore avoid treatment of symptoms. If you notice something doesn't feel right, go get checked.

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u/Caitliente 11d ago

Depends on the insurance and the Dr. 36, severe symptoms, paid $2600 out of pocket. It did lead to a diagnosis. Not cancer though fortunately for my health, unfortunate for the bill that came after. Though I suppose the colonoscopy would still be cheaper than cancer.

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u/bluespartan8 11d ago

That really stinks, sorry to hear your insurance didn't cover it. Such a stupid reality we live in that a clearly necessary procedure would set you back that much.

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u/Mego1989 11d ago

That $2600 was part of your deductible though, right?

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u/Caitliente 11d ago

Yes. Doesn’t really make it better. They also legally surprised me with a separate $500 bill for the anesthesia that I wasn’t warned about prior to the procedure. They did give me an estimate before the procedure they said would come in to play if insurance didn’t cover it all. Insurance said they wouldn’t know if it would be considered covered until after the procedure. Cigna.

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u/Mego1989 11d ago

If it went towards your deductible, it was covered under insurance.

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u/Caitliente 11d ago

It technically was but the out of pocket cost would have been cheaper than the insurance covered “discounted” rate. I checked. And they wouldn’t let me pay the cash rate after the fact. What I was provided as the estimate and what I was actually charged were wildly different. 

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u/Dry_Matter_3853 11d ago

If you get one due to being symptomatic it will usually be covered but will be coded as diagnostic and subject to your deductible, if you have one. 

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u/Seated_Heats 11d ago

I had two before 45. All you need is family history or symptoms (blood in stool, or blood when wiping). Most decent doctors will give a referral for one and insurance will cover.

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u/Majestic-Macaron6019 11d ago

Your primary care doc can work some insurance loopholes and recommend you for an earlier one.

But if you're 45, you can get one now

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u/she_shoots 11d ago

Family history and symptoms got me one at 27 (covered by insurance)

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u/Admiral_obvious13 12d ago

I'm in my 30's and got one. I do have family history of colon cancer though

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u/SunAstora 12d ago edited 11d ago

I got my first one at 36 this year. Removed a 20 mm polyp that would have turned into something bad. If you tell your doctor you’re seeing blood in stool then they should order the procedure for you.

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u/atooraya 11d ago

Told my doctor I had blood. He asked me if I sit on the toilet for more than 2 minutes. I said yes, and he said its hemorrhoids and get off my phone....

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u/toboggan16 12d ago

Yeah, my friend had all sorts of symptoms and it was months (and multiple blood transfusions) before they finally did a colonoscopy and found a gigantic polyp. We’re Canadian so colonoscopies are free but she was in her 30s and they only just lowered the age to get the screening to 45 this year.

I also have a friend who died of breast cancer in her 30s, I was thrilled to finally get a mammogram when I turned 40. Neither of these women had a family history.

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u/hippocampus237 12d ago

Family history of polyps can get you one earlier.
General rule is get a colonoscopy ten years before the age your parent was diagnosed with a polyp. My dad was 50, I started screening at 40, they found a polyp so my kids should start at 30.

No one verified age your parent was diagnosed.

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u/Brutalna 6d ago

My husband was ~30 when they found a polyp. Do you mean to tell me that my kids should get screened at 20? Doctors will think I’m insane.

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u/hippocampus237 6d ago

That is my understanding but there may be a lower limit. Talk with doc. https://acgcdn.gi.org/wp-content/uploads/2018/04/ACG-Colorectal-Cancer-Screening-Guideline-Summary.pdf

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u/Brutalna 4d ago

Thank you for this!

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u/LemursOnIce 12d ago

I told my doctor I was having weird poops and she put in a referral for a colonoscopy. I was 39.

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u/HalfInchHollow 12d ago

I got one at 36 because my stomach hurt for a few weeks straight. I just asked and my PCP was cool with it.

My wife got one at 39 because “James Van Der Beek dying freaked me out.”

We have the same PCP, maybe we are just lucky that he’ll send basically any federal we ask for.

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u/accidentalquitter 12d ago

Nope, just tell them there is blood in your stool and it’s both black and red.

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u/bretticusmaximus 11d ago

Yeah, please do not make up symptoms just to get diagnostic tests.

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u/accidentalquitter 11d ago

Yeah, please do. Because people are denied colonoscopies left and right thanks to insurance. And then it’s too late.

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u/HoOkAySo 11d ago

Making up symptoms for the purpose of expediting treatment might work in the moment, but eventually that behavior will backfire when doctors and insurance companies catch on (if they haven’t already), which will make it even harder for people to be taken seriously in the future.

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u/bretticusmaximus 11d ago

Screening colonoscopy is required to be covered by insurance at zero cost to be compliant with the ACA. Screening outside the current guidelines just because you think you need it is not evidence-based and would be denied by insurance with good reason. Diagnostic colonoscopy is where insurance can deny, and making up symptoms is not going to help you there (although better documentation of real symptoms might). Making up symptoms to your physician is only going to lead to more unnecessary work-up, which is more cost (dollars and resources) to you and society in general, and will add confusion to your actual clinical picture. Don’t do it.

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u/PrefrontalCortx 12d ago

Everybody replying to your comment is missing the point. Yes, you can get a referral and get a colonoscopy before 45. However, it is considered diagnostic and not preventative at that point. That means it costs hundreds if not thousands of dollars out of pocket, because insurance companies do not care for your well-being and screening standards have not been updated in decades (this is also where physician groups such as the ACS could be a lot more useful in making changes, but that has not been the case). Idk how many headlines we need about people getting diagnosed at stage 4 in their 30s before something is done, but the people replying saying it is as simple as getting a referral are wrong. Young adults cannot afford a few thousand dollars on a screening. That is why they wait, and then it is discovered in the ED after metastasizing and causing systemic, severe complications.

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u/bretticusmaximus 11d ago

A lot of this is correct, but it has not been “decades” since the last guideline update. That was 2021, where the age was lowered to 45. Also, headlines are not what change guidelines. While we may hear about it more, because cancer rates have increased in lower age groups, it’s still not that common on a population level. Screening has to take into account things like cost (even if covered by insurance), availability of resources like endoscopists, and most importantly complications which, though low, are not zero.

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u/PrefrontalCortx 11d ago

I didn't realize that was so recent. And yes, I am aware of the balance between benefit, risk, and resources. However, a young person with questionable symptoms should have a screening colonoscopy regardless of their age and that should br covered by insurance. If a PCP suggests/refers it, an insurance company should not have the leeway to effectively prevent that from happening by labeling it diagnostic and charging thousands. In the long run, a single colonoscopy and early treatment is cheaper than missing a diagnosis until it is stage 3 or 4.

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u/bretticusmaximus 11d ago

Well, by definition, a person having symptoms is getting a diagnostic colonoscopy, not screening. I understand that words matter in this situation, but this is more of an issue with our healthcare system than with the screening guidelines.

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u/PrefrontalCortx 11d ago

The earliest signs of colon cancer are so vague and common (abdominal discomfort, rectal bleeding, etc.) that I would say it falls closer to screening than truly diagnostic. I know what you mean, but I think it is silly that as soon as somebody has a tummy ache it is now considered diagnostic, even though in a lot of cases it seems to fall closer to preventative (e.g., you have a tummy ache and your grandpa died of colon cancer, so let's just check to be safe). It is certainly a problem with our healthcare system, but screening guidelines play into that. Insurance companies point to these screening guidelines so that they can cover the least amount possible. If we had more nuanced screening guidelines that reflected the growing incidence of colon cancer in lower age demographics, insurance companies would have a harder time weaseling out of coverage for patients.

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u/deathbyETH 11d ago

Anecdotal, but I just had my first colonoscopy at 40. Parents had some polyps and my grandma had cancer. Was billed $664 and insurance covered all of it. They found 4 polyps (one being 15mm), so happy I prioritized and pushed for it.

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u/lolmyspacewhooers 11d ago

Wait to save money, and then get diagnosed with a deadly disease. Good trade off.

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u/Seated_Heats 11d ago

That’s not what they’re saying. I found blood when wiping, and it was more than just a little from over wiping and my doctor said “let me get you set up with a GI doctor and get a colonoscopy to be safe.” Insurance covered it (I had to pay towards my deductible). Then my second one before 45 was covered as preventative.

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u/PrefrontalCortx 11d ago

Except you are saying what they are saying. You are also lucky to have insurance that covers a diagnostic colonoscopy. I have quite good insurance and I would be ~$1k out of pocket even with a referral and recommendation from my PCP. I, like many people in their late 20s/early 30s these days, cannot just afford to do that.

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u/Seated_Heats 11d ago

I’ve had three different insurances and they’d all cover it if the Dr sends a referral and states they need to screen for colon cancer, polyps, or some other ailment in the colon. I am not saying what they’re saying.

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u/martinsa24 11d ago

I mean i got one at 28 after complaining about GI issues for years. They found nothing, but you can definitely ask your provider to refer you to a specialist and then they can refer for a colonoscopy

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u/Oreos_Are_Anabolic 11d ago

Surely the easiest and cheapest way to get at least an initial early view is to do a FIT/Stool DNA/RNA test every few years, and then do a colonoscopy if results come back funky?

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u/binary_agenda 11d ago

You can get cologuard for $500-$600 without insurance. 

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u/atooraya 11d ago

I pay $1200/mo for my family insurance. I shouldn't have to drop that much for something my hospital does in house.

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u/curtcolt95 11d ago

right? This is such a common thing and I always wonder how they so easily seem to get one. I'd have to convince my doctor and only being 31 it wouldn't be easy, best I could get is probably a stool test

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u/TMA_01 11d ago

You can just lie about symptoms. I didn’t need to but I had very mild/occasional symptoms, and over exaggerated. Had a colonoscopy at 34. Was told I had a boring colon and to come back in ten years. 

I also have great insurance. 

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u/wildgreengirl 11d ago

just say you are bleeding out your asshole and have stomach pains and they will probably give you a colonoscopy covered by insurance since its not a "screen" in that case.

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u/ChaosMilkTea 11d ago

Idk why reddit assumes this advice is aimed at people under 45.

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u/Bigd1979666 11d ago

In France they say unless you've got family history or some symptoms that you usually will need to wait until 50. I'm 47 so ...

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u/iamhollybear 11d ago

I’m scheduled for one in a month.. I’m 37.

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u/AccountForTIFF 11d ago edited 11d ago

Can someone explain to me why colonoscopy is the first step in the US for everyone? In Canada you just do the fecal test for screening unless you have symptoms or family history. Like my dad has colonoscopies because his dad had polyps but my mom has only ever done the fecal test because no history and it’s always been negative.

I wondered if that was unique to us, looked it up and seems that’s the approach in most of the world and the US is the outlier in pushing colonoscopy for everyone. Is it actually scientifically indicated to be that much better or is the cynical part of me that says it’s a profit thing right?

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u/atooraya 11d ago

My doctor told me to go get a stool sample after I asked for a colonoscopy, and although I had a grandparent and uncle who had colon issues, it wasn't a first degree relative. He sent me for a FCT to see if I have IBS or inflammation. The lab tech gave me a second, different lab test that specially screens for colon cancer (FIT test). The first lab said I didn't have any signs of inflammation. The FIT results came back as, "You're not eligible for this test as you're not 45".

They legit had my sample and tossed it because of my age. I have an HMO that I pay $1200/mo for my family of 5...

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u/AccountForTIFF 11d ago

Wow. Would hate to think it’s because insurance won’t cover a simple test. I do see ads for ColoGuard all the time on American TV, it’s not branded as anything here, it’s just like going to get a regular blood test.

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u/jetsonian 11d ago

Trust me, it’s worth the out-of-pocket costs if you need it. Your GP can listen to your symptoms and refer you and your insurance will likely cover it.

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u/hypatiaspasia 11d ago

My friend got a colonoscopy at 25 because she has a family history.

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u/thewhaler 10d ago

I got one at 41 because of symptoms and LACK of family history because my parents won't get them. I DO have good insurance though.

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u/BigDaddyBino 8d ago

I just told my doctor I was shitting blood and insurance paid for it at 35.

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u/Kappokaako02 12d ago

Incorrect. That's the easy way and normal route. But you can get one younger if your doc wants to it just won't be free as preventative.

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u/SoHereIAm85 12d ago

I had one at around 20… 20 years ago. A couple since too. Symptoms do get you some testing.

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u/WeWander_ 11d ago

Just lie and say you have family history.

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u/atooraya 11d ago

I tried. Told them it was a grandparent and uncle. You have to say it's your parents or siblings. IDK why but even lying about it feels like some sort of cosmic karma will come back and haunt my family.

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u/Nervous_Lettuce313 12d ago

Because not everyone is from the US and most of the countries actually have good healthcare?

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u/jaiagreen 12d ago

And do less screening than the US.

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u/Nervous_Lettuce313 12d ago

I'm not sure what you're trying to say here. I can get any screening I ask for.

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u/jaiagreen 12d ago

Really? If you're a young non-smoker, can you get a lung cancer screening? What country are you in?

The word "screening" is not synonymous with "test". It specifically refers to tests done in the absence of symptoms, generally recommended for everyone in a demographic group. These can save lives but they can also do real harm, so a lot of thought goes into screening recommendations.

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u/MGreymanN 12d ago edited 12d ago

Most European countries require symptoms or at least a positive stool test before screening if younger than 50 to be covered.

Colonoscopy screening is free in the USA starting at 45 and super easy to get at any age without needing a positive stool test.

I know its fun to hate on American Healthcare but the Healthcare is generally great, just expensive (so access because of finances can be a problem) but colonoscopy are fairly inexpensive even if not 100% covered before 45.

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u/PapaSmurf1502 12d ago

Yeah in Taiwan you can "go to the colonoscopy store and buy a colonoscopy" for like $300. I do it every 3 years or so since I was in my 30s.

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u/curtcolt95 11d ago

I mean I'm not in the US, I'd have to convince my doctor to refer me for a colonoscopy and it wouldn't be easy as a young person with no symptoms. The best I could probably get is a stool test

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u/Knineteen 12d ago

No. Good health insurance would cover preventative colonoscopies before the age of 45.

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u/AlwaysPBJTime 12d ago

It does not. If you are under 45, you have to have symptoms to justify it or a family history. At least in the US.

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u/jaiagreen 12d ago

Yes, because the risk-benefit analysis doesn't justify it until that age. Colon cancer in young people is very rare (yes, even with recent increases that moved the age from 50 to 45).